Sustainable Implementation Research Articles

Do you wanna dance? Tales of trust and driving trust factors in robot medication counseling in the pharmacy context.

Introduction: The sustainable implementation of socially assistive robots in a pharmacy setting requires that customers trust the robot. Our aim was to explore young adults' anticipations of and motives for trusting robot medication counseling in a high-stakes scenario. Methods: Through a co-creation approach, we co-designed a prototype application for the Furhat platform together with young adults. In-lab testing of a pharmacy scenario, where the robot provides medication counseling related to emergency contraceptive pills, was conducted to deepen our understanding of some factors driving young adults' initial trust establishment and anticipations of interacting with a robot in a high-stakes scenario. Qualitative data from interviews with six study participants were analyzed using inductive, reflexive thematic analysis and are presented through a narrative approach. Results: We outline five tales of trust characterized by personas. A continuum of different anticipations for consulting a robot in medication counseling is presented, ranging from low to high expectations of use. Driving factors in the initial trust establishment process are position, autonomy, boundaries, shame, gaze, and alignment. Discussion: The article adds to the understanding of the dimensions of the multifaceted trust concept, of driving trust factors, and of the subsequent anticipation to trust robots in a high-stakes pharmacy context.

Development and psychometric evaluation of the Implementation Support Competencies Assessment

BackgroundImplementation support practitioners (ISPs) are professionals that support others to implement evidence-informed practices, programs, and policies in various service delivery settings to achieve population outcomes. Measuring the use of competencies by ISPs provides a unique opportunity to assess an understudied facet of implementation science—how knowledge, attitudes, and skills used by ISPs affects sustainable change in complicated and complex service systems. This study describes the development and validation of a measure—the Implementation Support Competencies Assessment (ISCA)—that assesses implementation support competencies, with versatile applications across service contexts.MethodsRecently developed practice guide materials included operationalizations of core competencies for ISPs across three domains: co-creation and engagement, ongoing improvement, and sustaining change. These operationalizations, in combination with recent empirical and conceptual work, provided an initial item pool and foundation on which to advance measurement development, largely from a confirmatory perspective (as opposed to exploratory). The measure was further refined through modified cognitive interviewing with three highly experienced ISPs and pilot-testing with 39 individuals enrolled in a university-based certificate program in implementation practice. To recruit a sample for validation analyses, we leveraged a listserv of nearly 4,000 individuals who have registered for or expressed interest in various events and trainings focused on implementation practice offered by an implementation science collaborative housed within a research-intensive university in the Southeast region of the United States. Our final analytic sample included 357 participants who self-identified as ISPs.ResultsAssessments of internal consistency reliability for each competency-specific item set yielded evidence of strong reliability. Results from confirmatory factor analyses provided evidence for the factorial and construct validity of all three domains and associated competencies in the ISCA.ConclusionsThe findings suggest that one’s possession of high levels of competence across each of the three competency domains is strongly associated with theorized outcomes that can promote successful and sustainable implementation efforts among those who receive implementation support from an ISP. The ISCA serves as a foundational tool for workforce development to formally measure and assess improvement in the skills that are required to tailor a package of implementation strategies situated in context.

Effects of labyrinth-like path designs on mitigating stress response to traffic noise

Traffic noise poses significant mental health risks primarily through stress responses. Although labyrinths have been proven to reduce stress and promote relaxation, their efficacy in mitigating stress induced by traffic noise remains unclear. To address this issue, this study conducted repeated-measures experiments to investigate the effects of different labyrinth-like path designs on stress responses to traffic noise. Heart rate variability and electrodermal activity were measured using the E4 wristband to evaluate participants’ physiological stress levels. The results suggest that: (1) Walking on a continuous curved path layout (CS) effectively mitigated stress responses to traffic noise, as indicated by multiple physiological stress measures; (2) Regarding stress-mitigating path continuity attributes, 180-degree turns were positive attributes (p < 0.05), while 90-degree turns were negative attributes (p < 0.01); (3) Regarding stress-mitigating path layout features, curved segments (p < 0.01) and switchbacks (p < 0.05) were positive features, while U shapes were negative features (p < 0.01). This study indicates that labyrinth-like path designs can effectively mitigate stress responses to traffic noise; however, complex path layouts with frequent directional changes should be avoided in noisy environments, particularly in areas lacking resources for sound barriers and noise-absorbing vegetation. Our findings contribute to the development of evidence-based guidelines for designing stress-mitigating streets in high-traffic environments. When mainstreaming these guidelines through public codes, further comprehensive analyses including feasibility assessments, economic evaluations, and community engagement are warranted to ensure practical and sustainable implementation.

Feasibility and effectiveness of an evidence-based intervention bundle to improve peri-operative care of older adults

BACKGROUND Maintaining functional status is an essential therapeutic goal in peri-operative care of older adults. Although several recommendations concerning peri-operative management are available, pragmatic approaches to their sustainable implementation are lacking. OBJECTIVE Multiple evidence-based recommendations for peri-operative care of older adults were bundled into a multicomponent intervention and assessed for feasibility and effectiveness. DESIGN A quality improvement study with before–after comparison using a hybrid implementation-effectiveness approach. SETTING University Medical Centre. The trial was conducted from 2017 to 2020, follow-up was 1 week, 1 month and 6 months after surgery. PATIENTS Patients at least 65 years old were scheduled for surgery; excluded: intercranial, ophthalmological, and emergency surgery; planned postoperative stay in the intensive care unit. A total of 720 patients were eligible; 278 patients were recruited, 95 (34) of whom were female. INTERVENTIONS The intervention consisted of a set of recommended measures for peri-operative management of older patients, including pre-operative assessment and measures to manage frailty, malnutrition, polypharmacy, cognitive impairment and delirium. Patients were sequentially assigned to three groups: control (no change from usual care), transition (to implementation of the intervention) and intervention (fully implemented). MAIN OUTCOME MEASURES Feasibility was assessed by determining the level of implementation, and barriers were identified by conducting qualitative interviews with the medical staff. Intervention effectiveness was estimated by Instrumental Activities of Daily Living (IADL; Lawton and Brody, primary clinical outcome) 1 and six months postoperatively. The secondary outcomes included postoperative complications, cognitive performance, quality of life and length of hospital stay. RESULTS The implementation rate was 77%. Pre-operative IADL was 9.9/10 (range 8 to 10; SD 0.4) and 9.7/10 (6 to 10, 0.8) for the control and intervention groups, respectively. There was no statistically significant difference between the groups in IADL (0.07, 95% CI −0.23 to 0.36, P = 0.66) and 6 months after surgery (0.01, 95% CI −0.29 to 0.31, P = 0.95). CONCLUSION The implementation of evidence-based interventions to improve peri-operative care of older patients showed good feasibility in clinical routine but did not improve patients’ functional status, which was already at a high level pre-operatively. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT03325413

Digital Economy and Its Impact on Sustainable Business Practices: An Analytical Study in the Chinese Context

This research investigates integrating the digital economy with sustainable business practices in China, focusing on the dynamic nature of digital technology adoption and environmental sustainability within Chinese enterprises. The study aims to recommend effective strategies for enhancing sustainable innovation through digitalization, providing guidance for policymakers, corporate leaders, and managers. By selecting a sample of firms from 2008 to 2022, including data from companies listed on the stock exchange and detailed patent information, the study employs zero-inflated negative binomial regression to address the peculiarities of patent counts accurately. This method avoids the assumptions of linearity of dependent variables and normality of residuals common in many empirical innovation studies. The research confirms a positive relationship between digital adoption and green patents. Notably, there is a significant reduction in environmental outputs from firms operating in China’s 'Big Data Comprehensive Pilot Zone,' supporting the argument that policies promoting green innovation are effective. Additionally, the study identifies several key factors influencing the successful implementation of digital technologies and sustainability, including firm size, industry nature, and regional economic characteristics. These findings are crucial for policymakers and managers, emphasizing the importance of digitalization in achieving sustainability goals.

You Are Not Alone! Care Professionals‘ Acceptance of Telemedicine in Nursing Homes Comparing Pre- and Post-Implementation Evaluations

A lack of personnel in care institutions and high proportions of older people in need of care pose central challenges for today’s aging society, often resulting in the hospitalization of geriatric patients. In many cases, these hospitalizations are not medically necessary and cause deterioration of health. Applying telemedicine in nursing homes represents one approach aimed at a reduction of unnecessary hospitalizations of geriatric patients and supporting care personnel in medically uncertain situations. For a sustainable and successful implementation of technical innovations such as telemedical consultations, the care personnel’s perspectives and acceptance are especially essential. The Optimal@NRW project implemented telemedical consultations in 24 nursing homes in Germany, investigating medical and economic efficiency and in particular also the social acceptance of digital care in nursing homes. This paper presents quantitative results comparing the acceptance evaluations before (PRE: N = 130) and after (POST: N = 87) the implementation of the telemedical consultations in the nursing homes from the perspective of care professionals. The results showed positive evaluations of the telemedical consultations in both evaluation phases: POST evaluations especially showed a lower evaluation of perceived barriers of using telemedical consultations in nursing homes. This study’s insights enable one to derive guidelines and recommendations regarding the communication and information of telemedical applications considering the needs and wishes of care personnel as a central user group.

Sustainable Finance Implementation on Institutional Aspects in Indonesia and the European Union

Realizing sustainable finance practices towards a zero-carbon emission economy requires support and participation from all stakeholders, especially regulators from an institutional perspective. Sustainable finance is crucial in driving transformative economic growth towards sustainability. This study aims to scrutinizes the appropriate institutional elements that can bolster sustainable finance initiatives within Indonesia and the European Union (EU). Using the content analysis method, this research delves into various written media, regulations, laws, and documents. The study reveals that, from an institutional perspective, both the EU and Indonesia align their sustainable finance implementation with regulators' work plans, characterized by shared goals and objectives. However, technical complexities and evolving regulatory aspects pose challenges, stemming from the need to reconcile diverse political views and adapt to changing circumstances. The results indicate that while strong institutional frameworks and regulatory plans exist, practical implementation of sustainable finance faces hurdles. These include the need for clearer guidelines, enhanced inter-agency coordination, and more robust mechanisms to monitor and enforce compliance. Although sustainable finance initiatives in both regions show promise, continuous improvement and adaptation are essential to effectively contribute to a zero-carbon emission economy.

Sustainable implementation of technology in healthcare using the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability instrument

Sustainable implementation of technology in healthcare using the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability instrument

Supporting provision of quality of care through sustainable implementation of AgeTech for persons living with dementia in rural areas

Supporting provision of quality of care through sustainable implementation of AgeTech for persons living with dementia in rural areas

SUPERVISI FORMATIF TERHADAP PENINGKATAN KUALITAS PEMBELAJARAN DI MADRASAH TSANAWIYAH NEGERI 1 ACEH UTARA

The improvement of teaching and learning quality at Madrasah Tsanawiyah Negeri 1 Aceh Utara is an urgent need to strengthen the Islamic education system. In this context, the implementation of formative supervision strategy becomes the main focus in enhancing the effectiveness of learning. This research aims to analyze the impact of implementing formative supervision strategy on the quality of teaching and learning at the madrasah. The research method used is qualitative research with a case study approach. Data were obtained through classroom observations, interviews with teachers and educational staff, as well as analysis of curriculum-related documents and learning evaluations. The results show that formative supervision is effective in improving the quality of teaching and learning at Madrasah Tsanawiyah Negeri 1 Aceh Utara. With formative supervision, teachers can receive constructive feedback, support in competency development, and enhance student engagement in the learning process. However, this research also identifies several challenges faced in implementing formative supervision, including the availability of adequate resources and managerial support. Therefore, recommendations are provided to enhance teacher training in formative supervision, improve collaboration between management and educational staff, and strengthen educational infrastructure to support sustainable implementation

Evaluation of the RISE II integrated social and behavior change approach in Niger: A contribution analysis.

Niger faces a myriad of health challenges and development efforts are complicated by persistent poverty, high population growth rates, and climate change. Integrated social and behavior change (SBC) addresses health outcomes through collective action and approaches at the limited points of entry individuals have with the health system. We conducted a mixed-methods study to evaluate the effectiveness of an integrated SBC program in the Maradi, and Zinder regions of Niger. We applied contribution analysis, a theory-based plausibility analysis, to assess contributions of the intervention. We found the program contributed to improved behavioral determinants. Male engagement and income generating activities provided further support for women to practice health behaviors. However, increases in male partner out-migration was negatively associated with health outcomes. While the program did not generate statistically significant improvements in health outcomes in the intervention area, exposure to health messages and participation in women's groups were positively associated with health outcomes suggesting sustained implementation of the integrated SBC approach at scale may achieve improved health outcomes. Programs should continue to invest in health promotion efforts that include gender sensitive interventions. Further research is needed to understand how women's agency and autonomy evolves as household composition changes through male out-migration.

Pendekatan Konsep Penerapan Green Infrastructure Pada Kawasan Perumahan Berbasis Komunal

This research aims to discuss policies and implementation of green infrastructure in Indonesia in communal-based housing areas. The references used for come from problems and best practices from other countries that have implemented green infrastructure. The method used is a descriptive method with a literature review approach. This research was carried out by understanding concepts, regulations, application of concepts, as well as identifying problems and providing recommendations related to green infrastructure in Indonesia. Based on the research results, there are six main regulations that serve as a reference for implementing green infrastructure in residential areas in Indonesia. Where the important thing in this regulation is Green Open Space (RTH) in the city with a minimum area proportion of 30%, rainwater storage is also set at a capacity of 50% of the amount of rainwater that falls according to annual rainfall and a general room temperature of 25 degrees Celsius. with relative humidity of 60%. The main problem is that 30% to 40% of carbon dioxide emissions are produced by buildings, which shows that buildings have a significant contribution to the process of environmental damage, as do residential areas. In Indonesia, the concept of green infrastructure that is applied is oriented towards zero energy use and the use of renewable energy. Holistic policy regulations are needed, from upstream to downstream as a form of implementing green infrastructure in residential areas, such as several developed countries in the world, namely the United States, England and Singapore, which have implemented policy regulations for sustainable implementation of green infrastructure in their countries.

PERAN PENYULUH DALAM IMPLEMENTASI USAHATANI JERUK NIPIS BERKELANJUTAN DI DESA LANDONO DUA KECAMATAN LANDONO KABUPATEN KONAWE SELATAN

The objective of this study is to ascertain the role of extension agents in the implementation of sustainable lime farming practices in Landono Dua Village, Landono District, South Konawe Regency. The population under investigation in this study consisted of lime farmers in Landono Dua Village, Landono District. The study sample was obtained through a census, resulting in a total of 49 individuals. This research employs a quantitative methodology. The variables under investigation are divided into two categories: the role of extension workers and the sustainability of lime farming. The data were collected through observation, interviews, and document analysis using questionnaires as the primary data collection instrument. The data were processed using a quantitative descriptive method, employing the class interval formula. The findings revealed that the role of agricultural extension agents can be classified into five distinct roles: facilitator, innovator, motivator, dynamizer, and educator. The role of agricultural extension workers in this study is categorized as positive, as evidenced by the effective implementation of the five roles identified. The sustainability of farming is divided into five aspects: ecological, economic, and social. The implementation of lime farming sustainability in this study is categorized as positive, indicating that the three aspects of sustainability have been applied effectively and have yielded positive results.

Implementasi Keberlanjutan Pengelolaan Dana Zakat Untuk Meningkatkan Kesejahteraan Masyarakat

This research aims to describe the sustainable implementation of zakat fund management to enhance community welfare at LKS Al-Yasini. Utilizing a qualitative approach, data collection techniques such as observation, interviews, and documentation were employed. Data analysis involved processing, classification, interpretation, and drawing conclusions. The findings reveal that the sustainable implementation of zakat fund management at LKS Al-Yasini has provided tangible benefits for the local community's welfare. However, several challenges persist in program implementation. Therefore, it is recommended that LKS Al-Yasini continue to evaluate and improve zakat fund management to enhance the effectiveness of the program.

Perspectives of healthcare practitioners on environmental sustainability in healthcare: A qualitative study.

To explore the perspectives of Kazakhstani healthcare professionals on environmental sustainability in healthcare. An exploratory qualitative design. Four focus group discussions (FGDs) on environmental sustainability in healthcare were conducted among healthcare professionals (nurses, physicians, midwives and physical therapists) from June to August 2023 in three cities of Kazakhstan. Each FGD consisted of at least 6 to 11 participants and lasted between 60 and 90 minutes. The collected data were analysed using the thematic analysis. A total of 137 initial codes were identified and further organized into 22 sub-themes based on similarities in codes and meanings, and then 5 significant themes were identified. The five main themes are 'Environmental Sustainability Practices in Healthcare', 'Purposes of Environmental Sustainability in Healthcare', 'Impact of Environmental Sustainability in Healthcare in Patients', 'Challenges in Implementing Environmental Sustainability in Healthcare' and 'The Role of Healthcare Leadership in Improving Environmental Sustainability in Healthcare'. The findings highlighted the perceptions and practices of healthcare professionals on environmental sustainability's purposes in healthcare, its impacts on patients and its implementation challenges. The study also underscored the critical role of strong and active leadership in ensuring a sustainable implementation of green policies in healthcare facilities and achieving successful results of environmentally conscious healthcare practices. The findings provide invaluable information that can be used by policymakers and healthcare organization leaders to create a sustainable healthcare system. Implementing environmental sustainability practices in healthcare should be widespread, intentional, and sustainable, entailing strong leadership and unwavering personal and organizational commitment. No patient or public contribution. We adhered to relevant EQUATOR guidelines, specifically the Consolidated Criteria for Reporting Qualitative Research.

Successful and sustained implementation of a behaviour-change informed strategy for emergency nurses: a multicentre implementation evaluation

BackgroundImplementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care.AimTo evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability).MethodsAn effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the ‘how’ and ‘why’ of quantitative results.ResultsHIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years.ConclusionThe behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts.Trial registrationANZCTR, ACTRN12621001456842. Registered 25 October 2021.

Sustainable Business Model Implementation in Polish Enterprises

Sustainable Business Model Implementation in Polish Enterprises

Using structural equation modeling to investigate students’ satisfaction with an undergraduate tutorial system

BackgroundThe undergraduate tutorial system (UTS) is a crucial measure in China for adhering to the principle of prioritizing foundational education, innovating the undergraduate talent training mode, and building a powerful country of higher education. This study investigated undergraduate students’ satisfaction with UTS and the influencing factors, aiming to promote the healthy and sustainable development of UTS and provide practical implications and suggestions for universities.MethodsBased on relevant theories, we conducted a survey study and leveraged structural equation modeling to assess students’ satisfaction with UTS and explore the influencing factors.ResultsOur Pearson correlation analysis showed that students’ satisfaction with mentors was positively correlated with dimensions such as humanistic care (r = 0.844, P < 0.05), mentor assistance (r = 0.906, P < 0.05), and mentor-student communication (r = 0.908, P < 0.05). Path analysis showed that mentor-student communication (β = 0.486, P < 0.01), mentor assistance (β = 0.228, P < 0.05), humanistic care (β = 0.105, P < 0.05) were positive factors affecting students’ satisfaction with mentors, while satisfaction with mentors (β = 0.923, P < 0.01) had a positive impact on students’ satisfaction with UTS. Students’ satisfaction with mentors explained 73.4% of the variation in students’ satisfaction with UTS, indicating that satisfaction with mentors was an important intermediary variable of UTS students.ConclusionThe sustainable implementation of UTS requires the effort to improve student satisfaction, and the breakthrough of strengthening the targeted mentorship in “transmitting wisdom, imparting knowledge, and resolving doubts” for students. Efforts should also be devoted to fostering students’ comprehensive skills and better serving the cultivation of talents in the new era.

C-reactive protein point-of-care testing in primary care-broader implementation needed to combat antimicrobial resistance.

This study presents the perspective of an international group of experts, providing an overview of existing models and policies and guidance to facilitate a proper and sustainable implementation of C-reactive protein point-of-care testing (CRP POCT) to support antibiotic prescribing decisions for respiratory tract infections (RTIs) with the aim to tackle antimicrobial resistance (AMR). AMR threatens to render life-saving antibiotics ineffective and is already costing millions of lives and billions of Euros worldwide. AMR is strongly correlated with the volume of antibiotics used. Most antibiotics are prescribed in primary care, mostly for RTIs, and are often unnecessary. CRP POCT is an available tool and has been proven to safely and cost-effectively reduce antibiotic prescribing for RTIs in primary care. Though established in a few European countries during several years, it has still not been implemented in many European countries. Due to the complexity of inappropriate antibiotic prescribing behavior, a multifaceted approach is necessary to enable sustainable change. The effect is maximized with clear guidance, advanced communication training for primary care physicians, and delayed antibiotic prescribing strategies. CRP POCT should be included in professional guidelines and implemented together with complementary strategies. Adequate reimbursement needs to be provided, and high-quality, and primary care-friendly POCT organization and performance must be enabled. Data gathering, sharing, and discussion as incentivization for proper behaviors should be enabled. Public awareness should be increased, and healthcare professionals' awareness and understanding should be ensured. Impactful use is achieved when all stakeholders join forces to facilitate proper implementation.

Social Processes of Public Sector Collaborations in Kenya: Unpacking Challenges of Realising Joint Actions in Public Administration

AbstractSocial processes behind the success or failure of collaborative implementation frameworks in African public administration contexts are under-researched. This paper addresses this gap by paying particular attention to trust attributes in collaborative implementation arrangements in Kenya. It shows how implementation challenges of policy programs and interventions may be linked to these interventions’ social characteristics in the public sector. The paper draws on a threefold approach of mutual trust and administrative data on public sector collaborative implementation arrangements for Kenyan anti-corruption policy like the Kenya Leadership Integrity Forum. Findings show that despite increased efforts to realise joint actions in public sector collaborative arrangements, they remain primarily symbolic and hierarchical and feature loose social cohesion among actors, producing challenges bordering on deficiencies in social processes of implementation. These include politicised aloofness or lack of commitment, unclear governance structures, coordination deficiencies, inter-agency conflicts, layered fragmentations, and overlapping competencies among different agencies. The paper recommends identifying and nurturing socially sensitive strategies embedded in mutual trust, like informal knowledge-sharing channels, to address primarily mandated public sector collaboration challenges in Kenya. Such efforts should consider systematic training and incentivising public managers to think outside inward-looking organisational cultures, allowing them to devise sustainable collaborative implementation approaches (promote open innovation) for policy programs, particularly anti-corruption policy.